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Reiter C, Puseljic M, Fuchsjäger M, Schmid J. Estimating synthetic hematocrit and extracellular volume from native blood pool T1 times at 3 Tesla CMR: Derivation of a conversion equation, accuracy and comparison with published formulas. Eur J Radiol 2024; 178:111659. [PMID: 39096824 DOI: 10.1016/j.ejrad.2024.111659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 07/27/2024] [Accepted: 07/29/2024] [Indexed: 08/05/2024]
Abstract
PURPOSE Calculation of extracellular volume fraction (ECV), a marker of myocardial fibrosis in cardiac magnetic resonance imaging (CMR), requires hematocrit (Hct). We aimed to correlate Hct levels with native blood T1 times, to derive a formula for estimating synthetic Hct (Hctsyn) and synthetic ECV (ECVsyn), to assess accuracy of ECVsyn and to compare our model with published formulas. METHOD In this retrospective study, a cohort of 250 CMR scans with T1 mapping (3T, MOLLI 5(3)3, endsystolic aquisition), was divided into a derivation and validation cohort. Native T1 times of the left ventricular blood pool (T1native,midLV) were correlated with Hct levels from blood sampling within 24 h (Hct24h) and a formula for calculation of Hctsyn was derived by linear regression. RESULTS In the derivation cohort (n = 167), Hct24h showed a good association with T1native,midLV (r = -0.711, p < 0.001). The resulting regression equation was Hctsyn = 1/T1native,midLV * 1355.52-0.310. In the validation cohort (n = 83), Hctsyn and Hct24h showed good correlation (r = 0.726, p < 0.001), while ECVsyn, and ECV24h demonstrated excellent correlation (r = 0.940, p < 0.001). ECVsyn had a minimal bias of 0.28 % and the misclassification rate (8.8 %) was comparable to the variability introduced by repeated Hct measurements (misclassification in 7.5 %). Applying published formulas in our cohort resulted in incorrect classification in up to 60 %. CONCLUSION We provide a formula for estimating Hctsyn from native blood T1 on a 3T scanner. The measurement error of ECVsyn is low and comparable to the error due to retest variability of conventional Hct. Scanner- and sequence-specific formulas should be used.
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Affiliation(s)
- Clemens Reiter
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8036 Graz, Austria.
| | - Marijan Puseljic
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8036 Graz, Austria.
| | - Michael Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8036 Graz, Austria.
| | - Johannes Schmid
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8036 Graz, Austria.
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Yin J, Qin J, Liu W, Zhu Y, Zhou X, Wang Y, Zhu X, Xu Y. A comparative study of synthetic and venous hematocrit for calculating cardiovascular magnetic resonance-derived extracellular volume. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-023-03044-0. [PMID: 38175388 DOI: 10.1007/s10554-023-03044-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 12/26/2023] [Indexed: 01/05/2024]
Abstract
The extracellular volume (ECV) fraction derived from cardiac magnetic resonance (CMR) can reflect various pathologies. The application of ECVs was limited by the strict requirement that hematocrit (Hct0) should be obtained within 24 hours of CMR scan. The aim of this study was to obtain accurate and convenient ECV calculated from the venous Hct and synthetic Hct in CMR. A total of 839 subjects were retrospectively enrolled. The subjects were divided into derivation cohort for local sex-specific models and validation cohort for assessing the accuracy of different ECVs. In the validation cohort, venous Hcts from 7 days before the scan (Hct1 - 7), outside 7 days (Hct> 7), the closest day (Hctclosest), and Hctsyn were compared with Hct0. The agreement and correlation of the conventional ECV (ECV0) with the corresponding ECVs were analyzed. The factors affecting the accuracy of ECVsyn were assessed. ECV1-7 and ECVclosest had the best correlation and smallest bias with ECV0 (R = 0.959 and 0.951, bias = 0.02% and - 0.03%). When using an absolute 2% error as the standard, the performance of ECV1-7 was the best, with an accuracy of 81.0%, followed by ECVclosest (78.8%), ECV> 7 (77.2%) and ECVsyn (70.7%). Abnormally low and high Hcts and decreased left ventricular ejection fractions were associated with miscalculation of ECVsyn, especially patients with dilated cardiomyopathy. We recommend extending the time interval between a Hct and a CMR scan to 7 days for ECV calculation. The synthetic ECV should be used cautiously, especially for patients with extremely low or high Hcts, decreased cardiac function, and dilated cardiomyopathy.
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Affiliation(s)
- Jiani Yin
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Nanjing, 210029, China
| | - Jie Qin
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Nanjing, 210029, China
| | - Wangyan Liu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Nanjing, 210029, China
| | - Yinsu Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Nanjing, 210029, China
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers Ltd, Shanghai, 200126, China
| | - Yunfei Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Nanjing, 210029, China
| | - Xiaomei Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Nanjing, 210029, China
| | - Yi Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Nanjing, 210029, China.
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Chehab O, Akl E, Abdollahi A, Zeitoun R, Ambale-Venkatesh B, Wu C, Tracy R, Blumenthal RS, Post WS, Lima JAC, Rodriguez A. Higher HDL cholesterol levels are associated with increased markers of interstitial myocardial fibrosis in the MultiEthnic Study of Atherosclerosis (MESA). Sci Rep 2023; 13:20115. [PMID: 37978334 PMCID: PMC10656454 DOI: 10.1038/s41598-023-46811-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023] Open
Abstract
Emerging research indicates that high HDL-C levels might not be cardioprotective, potentially worsening cardiovascular disease (CVD) outcomes. Yet, there is no data on HDL-C's association with other CVD risk factors like myocardial fibrosis, a key aspect of cardiac remodeling predicting negative outcomes. We therefore aimed to study the association between HDL-C levels with interstitial myocardial fibrosis (IMF) and myocardial scar measured by CMR T1-mapping and late-gadolinium enhancement (LGE), respectively. There were 1863 participants (mean age of 69 years) who had both serum HDL-C measurements and underwent CMR. Analysis was done among those with available indices of interstitial fibrosis (extracellular volume fraction [ECV]; N = 1172 and native-T1; N = 1863) and replacement fibrosis by LGE (N = 1172). HDL-C was analyzed as both logarithmically-transformed and categorized into < 40 (low),40-59 (normal), and ≥ 60mg/dL (high). Multivariable linear and logistic regression models were constructed to assess the associations of HDL-C with CMR-obtained measures of IMF, ECV% and native-T1 time, and myocardial scar, respectively. In the fully adjusted model, each 1-SD increment of log HDL-C was associated with a 1% increment in ECV% (p = 0.01) and an 18-ms increment in native-T1 (p < 0.001). When stratified by HDL-C categories, those with high HDL-C (≥ 60mg/dL) had significantly higher ECV (β = 0.5%, p = 0.01) and native-T1 (β = 7 ms, p = 0.01) compared with those with normal HDL-C levels. Those with low HDL-C were not associated with IMF. Results remained unchanged after excluding individuals with a history of myocardial infarction. Neither increasing levels of HDL-C nor any HDL-C category was associated with the prevalence of myocardial scar. Increasing levels of HDL-C were associated with increased markers of IMF, with those with high levels of HDL-C being linked to subclinical fibrosis in a community-based setting.
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Affiliation(s)
- Omar Chehab
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Elie Akl
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ashkan Abdollahi
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ralph Zeitoun
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Colin Wu
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Russell Tracy
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, VT, USA
| | - Roger S Blumenthal
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Wendy S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Joao A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Annabelle Rodriguez
- Center for Vascular Biology, University of Connecticut Health, Farmington, CT, USA.
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Chehab O, Akl E, Abdollahi A, Zeitoun R, Ambale-Venkatesh B, Wu C, Tracy R, Blumenthal R, Post W, Lima J, Rodriguez A. Higher HDL Cholesterol Levels Are Associated with Increased Markers of Interstitial Myocardial Fibrosis: Insights from The Multi-Ethnic Study of Atherosclerosis. RESEARCH SQUARE 2023:rs.3.rs-3299344. [PMID: 37790448 PMCID: PMC10543254 DOI: 10.21203/rs.3.rs-3299344/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background Emerging research indicates that high HDL-C levels might not be cardioprotective, potentially worsening cardiovascular disease(CVD)outcomes. Yet, there's no data on HDL-C's association with other CVD risk factors like myocardial fibrosis, a key aspect of cardiac remodeling predicting negative outcomes. We therefore aimed to study the association between HDL-C levels with interstitial myocardial fibrosis (IMF) and myocardial scar measured by CMR T1-mapping and late-gadolinium enhancement(LGE), respectively. Methods There were 1,863 participants (mean age of 69-years) who had both serum HDL-C measurements and underwent CMR. Analysis was done among those with available indices of interstitial fibrosis (extracellular volume fraction[ECV];N=1,172 and native-T1;N=1,863) and replacement fibrosis by LGE(N=1,172). HDL-C was analyzed as both logarithmically-transformed and categorized into <40 (low), 40-59 (normal), and ≥60mg/dL (high). Multivariable linear and logistic regression models were constructed to assess the associations of HDL-C with CMR-obtained measures of IMF, ECV% and native-T1 time, and myocardial scar, respectively. Results In the fully adjusted model, each 1-SD increment of log HDL-C was associated with a 1% increment in ECV%(p=0.01) and an 18-ms increment in native-T1(p<0.001). When stratified by HDL-C categories, those with high HDL-C(≥60mg/dL) had significantly higher ECV(β=0.5%,p=0.01) and native-T1(β =7ms,p=0.01) compared with those with normal HDL-C levels. Those with low HDL-C were not associated with IMF. Results remained unchanged after excluding individuals with a history of myocardial infarction. Neither increasing levels of HDL-C nor any HDL-C category was associated with the prevalence of myocardial scar. Conclusions Increasing levels of HDL-C were associated with increased markers of IMF, with those with high levels of HDL-C being linked to subclinical fibrosis in a community-based setting.
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Affiliation(s)
| | | | | | | | | | - Colin Wu
- National Heart Lung and Blood Institute
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5
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Chen W, Faragli A, Goetze C, Zieschang V, Weiss KJ, Hashemi D, Beyer R, Hafermann L, Stawowy P, Kelle S, Doeblin P. Quantification of myocardial extracellular volume without blood sampling. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2023; 1:qyad022. [PMID: 39045067 PMCID: PMC11195702 DOI: 10.1093/ehjimp/qyad022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/10/2023] [Indexed: 07/25/2024]
Abstract
Aims Cardiac magnetic resonance (CMR) T1 relaxation time mapping is an established technique primarily used to identify diffuse interstitial fibrosis and oedema. The myocardial extracellular volume (ECV) can be calculated from pre- and post-contrast T1 relaxation times and is a reproducible parametric index of the proportion of volume occupied by non-cardiomyocyte components in myocardial tissue. The conventional calculation of the ECV requires blood sampling to measure the haematocrit (HCT). Given the high variability of the HCT, the blood collection is recommended within 24 h of the CMR scan, limiting its applicability and posing a barrier to the clinical routine use of ECV measurements. In recent years, several research groups have proposed a method to determine the ECV by CMR without blood sampling. This is based on the inverse relationship between the T1 relaxation rate (R1) of blood and the HCT. Consequently, a 'synthetic' HCT could be estimated from the native blood R1, avoiding blood sampling. Methods and results We performed a review and meta-analysis of published studies on synthetic ECV, as well as a secondary analysis of previously published data to examine the effect of the chosen regression modell on bias. While, overall, a good correlation and little bias between synthetic and conventional ECV were found in these studies, questions regarding its accuracy remain. Conclusion Synthetic HCT and ECV can provide a 'non-invasive' quantitative measurement of the myocardium's extracellular space when timely HCT measurements are not available and large alterations in ECV are expected, such as in cardiac amyloidosis. Due to the dependency of T1 relaxation times on the local setup, calculation of local formulas using linear regression is recommended, which can be easily performed using available data.
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Affiliation(s)
- Wensu Chen
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, Berlin 13353, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Alessandro Faragli
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, Berlin 13353, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Potsdamer Str. 58, Berlin 10785, Germany
| | - Collin Goetze
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, Berlin 13353, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Victoria Zieschang
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, Berlin 13353, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Karl Jakob Weiss
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, Berlin 13353, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Potsdamer Str. 58, Berlin 10785, Germany
| | - Djawid Hashemi
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, Berlin 13353, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Potsdamer Str. 58, Berlin 10785, Germany
| | - Rebecca Beyer
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, Berlin 13353, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Lorena Hafermann
- Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Philipp Stawowy
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, Berlin 13353, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Potsdamer Str. 58, Berlin 10785, Germany
| | - Sebastian Kelle
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, Berlin 13353, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Potsdamer Str. 58, Berlin 10785, Germany
| | - Patrick Doeblin
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, Berlin 13353, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Potsdamer Str. 58, Berlin 10785, Germany
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Nickander J, Cole B, Nordin S, Vijapurapu R, Steeds RP, Moon JC, Kellman P, Ugander M, Kozor R. Increased cardiac involvement in Fabry disease using blood-corrected native T1 mapping. Sci Rep 2023; 13:4420. [PMID: 36932097 PMCID: PMC10023696 DOI: 10.1038/s41598-023-31211-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 03/08/2023] [Indexed: 03/19/2023] Open
Abstract
Fabry disease (FD) is a rare lysosomal storage disorder resulting in myocardial sphingolipid accumulation which is detectable by cardiovascular magnetic resonance as low native T1. However, myocardial T1 contains signal from intramyocardial blood which affects variability and consequently measurement precision and accuracy. Correction of myocardial T1 by blood T1 increases precision. We therefore deployed a multicenter study of FD patients (n = 218) and healthy controls (n = 117) to investigate if blood-correction of myocardial native T1 increases the number of FD patients with low T1, and thus reclassifies FD patients as having cardiac involvement. Cardiac involvement was defined as a native T1 value 2 standard deviations below site-specific means in healthy controls for both corrected and uncorrected measures. Overall low T1 was 135/218 (62%) uncorrected vs. 145/218 (67%) corrected (p = 0.02). With blood-correction, 13/83 previously normal patients were reclassified to low T1. This reclassification appears clinically relevant as 6/13 (46%) of reclassified had focal late gadolinium enhancement or left ventricular hypertrophy as signs of cardiac involvement. Blood-correction of myocardial native T1 increases the proportion of FD subjects with low myocardial T1, with blood-corrected results tracking other markers of cardiac involvement. Blood-correction may potentially offer earlier detection and therapy initiation, but merits further prospective studies.
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Affiliation(s)
- Jannike Nickander
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden.
| | - Ben Cole
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Sydney, Australia
| | - Sabrina Nordin
- Institute of Cardiovascular Science, University College London, London, UK
| | - Ravi Vijapurapu
- Institute of Cardiovascular Science, University of Birmingham, Birmingham, UK
| | - Richard P Steeds
- Institute of Cardiovascular Science, University of Birmingham, Birmingham, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, London, UK
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Sydney, Australia
- Charles Perkins Center, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Rebecca Kozor
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Sydney, Australia
- Royal North Shore Hospital, North Shore Private Hospital, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
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Rosmini S, Seraphim A, Knott K, Brown JT, Knight DS, Zaman S, Cole G, Sado D, Captur G, Gomes AC, Zemrak F, Treibel TA, Cash L, Culotta V, O’Mahony C, Kellman P, Moon JC, Manisty C. Non-invasive characterization of pleural and pericardial effusions using T1 mapping by magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 2022; 23:1117-1126. [PMID: 34331054 PMCID: PMC9612798 DOI: 10.1093/ehjci/jeab128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Indexed: 12/20/2022] Open
Abstract
AIMS Differentiating exudative from transudative effusions is clinically important and is currently performed via biochemical analysis of invasively obtained samples using Light's criteria. Diagnostic performance is however limited. Biochemical composition can be measured with T1 mapping using cardiovascular magnetic resonance (CMR) and hence may offer diagnostic utility for assessment of effusions. METHODS AND RESULTS A phantom consisting of serially diluted human albumin solutions (25-200 g/L) was constructed and scanned at 1.5 T to derive the relationship between fluid T1 values and fluid albumin concentration. Native T1 values of pleural and pericardial effusions from 86 patients undergoing clinical CMR studies retrospectively analysed at four tertiary centres. Effusions were classified using Light's criteria where biochemical data was available (n = 55) or clinically in decompensated heart failure patients with presumed transudative effusions (n = 31). Fluid T1 and protein values were inversely correlated both in the phantom (r = -0.992) and clinical samples (r = -0.663, P < 0.0001). T1 values were lower in exudative compared to transudative pleural (3252 ± 207 ms vs. 3596 ± 213 ms, P < 0.0001) and pericardial (2749 ± 373 ms vs. 3337 ± 245 ms, P < 0.0001) effusions. The diagnostic accuracy of T1 mapping for detecting transudates was very good for pleural and excellent for pericardial effusions, respectively [area under the curve 0.88, (95% CI 0.764-0.996), P = 0.001, 79% sensitivity, 89% specificity, and 0.93, (95% CI 0.855-1.000), P < 0.0001, 95% sensitivity; 81% specificity]. CONCLUSION Native T1 values of effusions measured using CMR correlate well with protein concentrations and may be helpful for discriminating between transudates and exudates. This may help focus the requirement for invasive diagnostic sampling, avoiding unnecessary intervention in patients with unequivocal transudative effusions.
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Affiliation(s)
- Stefania Rosmini
- Department of Cardiac Imaging, Barts Heart Centre, St Bartholomew’s Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
- King’s College Hospital NHS Trust Foundation, Denmark Hill, London SE5 9RS, UK
| | - Andreas Seraphim
- Department of Cardiac Imaging, Barts Heart Centre, St Bartholomew’s Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Kristopher Knott
- Department of Cardiac Imaging, Barts Heart Centre, St Bartholomew’s Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - James T Brown
- Royal Free London NHS Foundation Trust, Pond St, London NW3 2QG, UK
| | - Daniel S Knight
- Royal Free London NHS Foundation Trust, Pond St, London NW3 2QG, UK
| | - Sameer Zaman
- Imperial College London, Imperial College, Healthcare NHS Trust, South Kensington, London SW7 2BX, UK
| | - Graham Cole
- Imperial College London, Imperial College, Healthcare NHS Trust, South Kensington, London SW7 2BX, UK
| | - Daniel Sado
- King’s College Hospital NHS Trust Foundation, Denmark Hill, London SE5 9RS, UK
| | - Gabriella Captur
- Department of Cardiac Imaging, Barts Heart Centre, St Bartholomew’s Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
- Institute for Cardiovascular Sciences, University College London, 62 Huntley St, London WC1E 6DD, UK
| | - Ana Caterina Gomes
- Department of Cardiac Imaging, Barts Heart Centre, St Bartholomew’s Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Filip Zemrak
- Department of Cardiac Imaging, Barts Heart Centre, St Bartholomew’s Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Thomas A Treibel
- Department of Cardiac Imaging, Barts Heart Centre, St Bartholomew’s Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Lizette Cash
- Department of Cardiac Imaging, Barts Heart Centre, St Bartholomew’s Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Veronica Culotta
- Department of Cardiac Imaging, Barts Heart Centre, St Bartholomew’s Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Constantinos O’Mahony
- Department of Cardiac Imaging, Barts Heart Centre, St Bartholomew’s Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Peter Kellman
- National Heart, Lung and Blood Institute, National Institutes of Health, Medical Signal and Imaging Processing Program, 10 Center Dr, Bethesda, MD 20814, USA
| | - James C Moon
- Department of Cardiac Imaging, Barts Heart Centre, St Bartholomew’s Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
- Institute for Cardiovascular Sciences, University College London, 62 Huntley St, London WC1E 6DD, UK
| | - Charlotte Manisty
- Department of Cardiac Imaging, Barts Heart Centre, St Bartholomew’s Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
- Institute for Cardiovascular Sciences, University College London, 62 Huntley St, London WC1E 6DD, UK
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Neumann K, Günther M, Düzel E, Schreiber S. Microvascular Impairment in Patients With Cerebral Small Vessel Disease Assessed With Arterial Spin Labeling Magnetic Resonance Imaging: A Pilot Study. Front Aging Neurosci 2022; 14:871612. [PMID: 35663571 PMCID: PMC9161030 DOI: 10.3389/fnagi.2022.871612] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
In this pilot study, we investigated microvascular impairment in patients with cerebral small vessel disease (CSVD) using non-invasive arterial spin labeling (ASL) magnetic resonance imaging (MRI). This method enabled us to measure the perfusion parameters, cerebral blood flow (CBF), and arterial transit time (ATT), and the effective T1-relaxation time (T1eff) to research a novel approach of assessing perivascular clearance. CSVD severity was characterized using the Standards for Reporting Vascular Changes on Neuroimaging (STRIVE) and included a rating of white matter hyperintensities (WMHs), lacunes, enlarged perivascular spaces (EPVSs), and cerebral microbleeds (CMBs). Here, we found that CBF decreases and ATT increases with increasing CSVD severity in patients, most prominent for a white matter (WM) region-of-interest, whereas this relation was almost equally driven by WMHs, lacunes, EPVSs, and CMBs. Additionally, we observed a longer mean T1eff of gray matter and WM in patients with CSVD compared to elderly controls, providing an indication of impaired clearance in patients. Mainly T1eff of WM was associated with CSVD burden, whereas lobar lacunes and CMBs contributed primary to this relation compared to EPVSs of the centrum semiovale. Our results complement previous findings of CSVD-related hypoperfusion by the observation of retarded arterial blood arrival times in brain tissue and by an increased T1eff as potential indication of impaired clearance rates using ASL.
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Affiliation(s)
- Katja Neumann
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- *Correspondence: Katja Neumann
| | - Matthias Günther
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
- MR-Imaging and Spectroscopy, University of Bremen, Bremen, Germany
- mediri GmbH, Heidelberg, Germany
| | - Emrah Düzel
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
- Center for Behavioral Brain Science, Magdeburg, Germany
| | - Stefanie Schreiber
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Center for Behavioral Brain Science, Magdeburg, Germany
- Department of Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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Hermann I, Uhrig T, Chacon-Caldera J, Akçakaya M, Schad LR, Weingärtner S. Towards measuring the effect of flow in blood T 1 assessed in a flow phantom and in vivo. Phys Med Biol 2020; 65:095001. [PMID: 32160594 DOI: 10.1088/1361-6560/ab7ef1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Measurement of the blood T 1 time using conventional myocardial T 1 mapping methods has gained clinical significance in the context of extracellular volume (ECV) mapping and synthetic hematocrit (Hct). However, its accuracy is potentially compromised by in-flow of non-inverted/non-saturated spins and in-flow of spins which are not partially saturated from previous imaging pulses. Bloch simulations were used to analyze various flow effects separately. T 1 measurements of gadolinium doped water were performed using a flow phantom with adjustable flow velocities at 3 T. Additionally, in vivo blood T 1 measurements were performed in 6 healthy subjects (26 ± 5 years, 2 female). To study the T 1 time as a function of the instantaneous flow velocity, T 1 times were evaluated in an axial imaging slice of the descending aorta. Velocity encoded cine measurements were performed to quantify the flow velocity throughout the cardiac cycle. Simulation results show more than 30% loss in accuracy for 10% non-prepared in-flowing spins. However, in- and out-flow to the imaging plane only demonstrated minor impact on the T 1 time. Phantom T 1 times were decreased by up to 200 ms in the flow phantom, due to in-flow of non-prepared spins. High flow velocities cause in-flow of spins that lack partial saturation from the imaging pulses but only lead to negligible T 1 time deviation (less than 30 ms). In vivo measurements confirm a substantial variation of the T 1 time depending on the flow velocity. The highest aortic T 1 times are observed at the time point of minimal flow with increased flow velocity leading to reduction of the measured T 1 time by up to [Formula: see text] at peak velocity. In this work we attempt to dissect the effects of flow on T 1 times, by using simulations, well-controlled, simplified phantom setup and the linear flow pattern in the descending aorta in vivo.
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Affiliation(s)
- Ingo Hermann
- Magnetic Resonance Systems Lab, Department of Imaging Physics, Delft University of Technology, Lorentzweg 1, 2628 Delft, Netherlands. Computer Assisted Clinical Medicine, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
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